Implant size with Breast lift to fill out upper pole
In general, you are correct: most surgeons use a lower profile implant in conjunction with a breast lift if upper pole fullness is requested or needed. Whether saline or silicone is better is more dependent on the shape of the implant than how it is filled. Yes, in general, saline implants are slightly more projected than gel because saline implants are overfilled. I usually recommend gel implants for all my patients since I believe they are a superior product. A low profile gel implant should suit your needs nicely.
It is great that you have done extensive research in preparation for your upcoming surgery. However, I would caution you to communicate your goals clearly with your surgeon (I like to use pictures as the clearest communication tool) and to allow your surgeon some discretion in the operating room.
The more breast surgery I do the more I realize that there is no correlation between the size or model (profile) of implant used and resulting cup size. This may have to do with several factors including: the amount of breast volume the patient starts with, the shape of the patient's chest wall (concave or convex), the type and model of breast implant selected (saline/silicone and low/moderate/high profile), bra manufacturer variance in cup sizes, the degree of filling of the cup with breast tissue, and the subjective differences in patients perceptions of cup size.
Much of the final “look” achieved after breast augmentation surgery depends on several factors:
1. The initial shape, size (volume of breast tissue), symmetry of the patient's breasts. In general, the better the preoperative breast appearance the more likely the breast augmentation “look” will be optimal.
2. The experience/skill level of the surgeon is important in determining the final outcome. For example, the accurate and gentle dissection of the breast implant pockets are critical in producing long-term well-placed breast implants. I personally think that these 2 factors are more important than any others, including type (saline or silicone) or model (low/moderate/high profile) of implant.
3. The type of implant used may determine the final outcome, especially if the patient does not have significant covering breast or adipose tissue. For example, some surgeons feel that silicone implants have a more natural look and feel than saline implants because silicone gel has a texture that is similar to breast tissue. Each patient differs in the amount of breast tissue that they have. If a patient has enough breast tissue to cover the implant, the final result will be similar when comparing saline implants versus silicone gel implants. If a patient has very low body fat and/or very little breast tissue, the silicone gel implants may provide a more "natural" result.
On the other hand, saline implants have some advantages over silicone implants. Silicone implant ruptures are harder to detect. When saline implants rupture, they deflate and the results are seen almost immediately. When silicone implants rupture, the breast often looks and feels the same because the silicone gel may leak into surrounding areas of the breast without a visible difference. Patients may need an MRI to diagnose a silicone gel rupture. Saline implants are also less expensive than the silicone gel implants.
Other differences involve how the breast implants are filled. Saline implants are filled after they’re implanted, so saline implants require a smaller incision than prefilled silicone breast implants.
On May 10, 2000, the FDA granted approval of saline-filled breast implants manufactured by Mentor Corporation and McGhan Medical. To date, all other manufacturers’ saline-filled breast implants are considered investigational.
As of 2006, the FDA has approved the use of silicone gel implants manufactured by the Mentor Corporation and Allergan (formerly McGhan) for breast augmentation surgery for patients over the age of 22.
4. The size and model of breast implant used may make a significant difference in the final outcome. Therefore, it is very important to communicate your size goals with your surgeon. In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. I have found that the use of words such as “natural” or “C cup” or "fake looking" or "top heavy" means different things to different people and therefore prove unhelpful.
Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup size may also be inaccurate.
I use intraoperative sizers and place the patient in the upright position to evaluate breast size. Use of these sizers also allow me to select the breast implant profile (low, moderate, moderate plus, high-profile) that would most likely achieve the patient's goals. The patient's goal pictures are hanging on the wall, and allow for direct comparison.
I have found that this system is very helpful in improving the chances of achieving the patient's goals as consistently as possible.
By the way, the most common regret after this operation, is “I wish I was bigger”.
I hope this helps.
Choosing the right implant fo ryou really depends upon your goals and dimensions. These are best determined in person during an exam.
A moderate sized implant with an appropriate base diameter should help you acheive your goal of improved upper pole fullness without making you too large. With the information that you posted it would seem that a good percentage of the implant volume would be directed to upper pole fullness.
Silicone vs saline for breast lift
The differences in silicone vs saline are primarily the look and feel being much more natural with silicone gel than saline and saline not requiring significant follow up. The dimensions are close enough with all the varieties of implants available that dimension should not be the reason to chose saline or silicone. You should also be aware that any implant will add volume to your breasts so your size will increase.
Silicone or saline implants with mastopexy
Both saline and silicone gel implants work very well for augmentation with mastopexy, and you should not let very small dimensional differences concern you. You have raised an issue with increasing the size of your breast a small amount, perhaps just one half to one cup size, small B to full B, with your breast lift. You mentioned also that your implant will be placed under the muscle. My concerns with augmentation breast lift are this: will the implant be large enough to fill out the skin envelope adequately if placed under the muscle? In a lift, or even augmentation for that matter, we need a good marriage between the breast and implant; they need to feel as one. If the implant is small and under the muscle there can be a disconnect between the two, and in worse case the implant will be 'held' by the muscle and the breast freely move over the surface. If the skin is loose, and the augmentation small I would favor a subglandular silicone implant with your mastopexy. I have not seen you and do not know the whole picture, though I suggest you raise the issue so that you fully understand what your surgeon feels is best and why.
Best of luck,
Silicone breast implants for more upper pole volume
"I've been looking at Mentor's dimensions for both saline and silicone moderate round implants. It seems that the silicone is wider with less projection, while saline is narrower with more projection. Since all I want is to fill my upper pole and not go up in size, would silicone be a better choice?"
It sounds like you are comparing MENTOR's HIGH PROFILE Smooth Silicone Gel implants with the Mentor Style 2000 Moderate Plus Saline implants. For all practical purposes these implants have VERY close dimensions and I use them frequently.
With a breast diameter of 13.5 cm you have a VERY large amount of implant choices before you. You COULD go with a smaller gel implant (which would be totally covered by the breast) ABOVE the muscle but the results often appear "done" despite the upper pole fullness. Or, you could go with a larger submuscular implant. I do NOT think it makes a difference. Gel implants are lighter, ripple less and have slightly more upper pole fullness.
Upper breast fullness with breast implants and lift (mastopexy)
Clearly the best technique to achieve upper pole fullness is placing the implant ABOVE the muscle.
There may be compelling reasons to place them under the muscle but this is the single most important technique to acheive upper pole fullness.
I am not sure about the other part of your question which namely comes down to:
Which implant achieves the greates upper pole fullness: a larger diameter or a higher projection implant?
Breast implants and lifts for upper pole fullness
First of all, you are doing good research. You should have implants under the muscle and the implant should have a base width that fits your breast's base width. At 13.5 cm, the volume of a moderate profile implant WILL add size to you. There is no way to add upper pole volume without adding cup size. So, try to forget the cup size restriction and go for the final "look" you want. Let the cup size just follow that.